Organization
FOGG/ZAREIE ENTERPRISES INC.
Active
Other names
Athens Family Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT SAMUEL FOGG (BUSINESS MANAGER)
(706) 548-3279
Entity
Organization
Contact information
Practice address
3380 OLD JEFFERSON RD, ATHENS, GA 30607-1480
(706) 548-3279
(706) 546-6475
Mailing address
3380 OLD JEFFERSON RD, ATHENS, GA 30607-1480
(706) 548-3279
(706) 546-6475
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
006805
GA
1223G0001X
General Practice Dentistry
009000
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00176778C
—
GA
05
—
00508065A
—
GA
05
—
00862705A
—
GA
05
—
00915516A
—
GA
Enumeration date
03/18/2008
Last updated
03/18/2008
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